Cath Staincliffe - Go Not Gently

He patted the papers back into the manila folder. ‘No,’ he said, ‘nothing. I’d have been very surprised if there had been. In the sort of case you’re asking about,’ he explained, ‘we’d look for a certain sort of physical problem, an untreated infection, perhaps, from which we could date the development of the confusion. Now we’ve nothing like that here, absolutely nothing.’ He stressed the words. ‘She had a full medical on arrival at Homelea, sort of MOT,’ he smiled insincerely and waved the folder, ‘and everything I’ve seen of Mrs Palmer makes me certain that she has chronic dementia, Alzheimer’s. I’m sorry. I can assure you we are doing our best for her.’

Agnes suddenly looked much older, the brilliance of her dark eyes dulled. ‘But it’s all been so quick,’ she said. ‘She doesn’t know who I am any more.’ The last words came out in a whisper as she fought to stay in control.

‘There are peaks and troughs,’ said Dr Goulden, ‘as with any chronic disease. The situation may well improve. Often adjusting the medication can help things considerably. With some patients the situation can stabilise and remain so for many months.’

‘What medicine is she getting?’ I asked.

He looked at me. That smile again. ‘She’s currently receiving a controlled-dose tranquilliser, what we call an antipsychotic drug, and she’s given something to help her sleep if Mrs Knight judges it to be necessary. Drugs have a very useful role in Mrs Palmer’s therapy but we use them with caution. The tranquilliser, for example, wouldn’t be given on a long-term basis.’

‘Is it one of the phenothiazines?’ I asked, remembering what I’d read in Moira’s books and hoping I’d got the pronunciation right. ‘What dosage is she on?’

This time the smile was accompanied by a patronising tilt of the head. ‘I don’t see that such detail is of much help to the layperson in understanding our care plan.’

‘We’d like to know,’ I said. No explanation, no justification.

He cleared his throat and rustled papers. ‘Thioridazine,’ he said. ‘Twenty-five milligrams twice daily. And nitrazepam for the insomnia as required.’

‘There can sometimes be side effects, can’t there?’ asked Agnes. ‘The drugs themselves can cause confusion in some people, make things worse.’

‘Yes, on occasion. All drugs carry some risk of minor side effects. But on the whole we feel the benefits far outweigh any risks. I can assure you I’ll be monitoring the response to the medication very carefully. There’s usually a settling-down period before the situation stabilises. If I see any indication of an adverse reaction I’ll reduce or withdraw the medication. I’d be hoping to gradually phase it out anyway. As I say, it’s not something I see Mrs Palmer requiring on a long-term basis.’

‘And you don’t think any of her symptoms are due to the drugs themselves?’ I asked.

‘No, definitely not. The confusion and agitation were what indicated the need for treatment in the first place. They’ve not arisen as a reaction to the medicines, they were present before the drug therapy started.’ He placed Lily’s notes on top of the neat stack on his desk. ‘Once the situation has stabilised, as I’m sure it will, I think we’ll see substantial improvement and we’ll have a much calmer and more relaxed patient.’

He stood up and picked up Lily’s notes, batting them gently against his other hand as he waited for us to leave. Agnes went ahead of me. As she opened the door I glanced back into the room. Dr Goulden was standing at his filing cabinet putting the notes away. But it was his reflection in the mirror above the cabinet that caught my attention. His face was contorted with rage, lips drawn back, taut and white, teeth bared, eyes glaring. My stomach lurched. It was an astonishing sight. I slipped out before he noticed me looking.

It was curiosity made me return to the building. I found it hard to credit what I’d seen and wanted to nose around a bit more. I settled Agnes in the car and then claimed to have left my gloves in the waiting room. The lobby was deserted – we must have been the last appointment.

The words from the consulting room were a little muffled behind the closed door, but I could make out most of what Goulden said, particularly at such a loud volume. ‘I do not see friends and relatives. I’m a doctor, not a bloody support group. I see patients. You make appointments for patients.’ He was furious, spitting out the words, ladling on scorn and derision. ‘Next time you decide to offer appointments to Uncle Tom Cobleigh and all just use your bloody brains, woman.’

I heard a murmur in reply.

‘Tell them you only make appointments for registered patients. Show some initiative, for Christ’s sake. Anything else, you check with me first. Got it?’

Another murmur.

‘I’ve enough to do without being at the beck and call of every silly old bat who gets a bee in her bonnet. They read an article in some half-cocked magazine and next minute they’re God’s gift to medicine. Check next time and if they’re not patients…’

I left. I’d heard enough and I didn’t want the receptionist to know I’d witnessed her humiliation.

In the car Agnes was deflated. Goulden’s certainty about Lily’s illness had put paid to any hope she might have had about misdiagnosis. And he had given us the information we asked for even though we’d had to lean on him to get it. But she hadn’t seen what I had, nor heard him just now.

‘I think he’s hiding something,’ I said, ‘he hated having to see us, he didn’t want to talk to us about Lily.’

I described to Agnes the expression I’d seen on Goulden’s face as I was leaving and the way he’d bawled out his receptionist.

‘He was beside himself,’ I said. ‘That makes me wonder, why did our visit upset him to such a degree?’

‘Perhaps he’s just a very angry man. Choleric they used to call it.’

‘I don’t like him,’ I said, ‘and I wouldn’t trust him as far as I can spit.’

Dr Chattaway used an end terraced house for his surgery. Plastic chairs were arranged around the walls of the room. On a table in the centre were copies of People’s Friend, National Geographic and Woman’s Own. The waiting room was full. No intercom here. The doctor stuck his head round the door every few minutes and asked for the next patient. People shuffled along each time.

Gradually we moved around the room and finally we reached the inner sanctum. Dr Chattaway motioned to chairs and settled behind his highly polished desk. It was huge; they probably had to dismantle it to get it through the doorway. On the wall were framed diplomas and a photograph of Dr Chattaway in cap and gown.

‘Miss Donlan,’ he grinned, ‘how are you? I haven’t seen you for a while.’ His accent blended Indian consonants and Mancunian vowels.

Agnes explained why we’d come. He listened politely, rolling a thick fountain pen between his fingers and frowning slightly. When she’d finished he nodded once.

‘Of course I no longer have Mrs Palmer’s notes. As you know, I treated Mrs Palmer for the fall, the shoulder, and that was mending fine, but she was keen to move into sheltered accommodation. I didn’t see her again, she transferred to Dr Goulden. I’m sorry to hear she’s so poorly.’

I asked him if Lily had ever shown any signs of dementia.

She hadn’t. But neither had she had any acute illness that could have led to dementia-like symptoms. He recommended that we ask Dr Goulden to make sure there was no adverse reaction to drugs she was prescribed. ‘It’s a common enough problem,’ he said. ‘All drugs have side effects and sometimes switching to another similar drug can bring great improvements. I must say I am surprised that she is so ill. I would agree it seems very sudden and if she were my patient I would be reviewing the drugs very carefully.’